ADHD is commonly treated with a stimulant medication like Adderall, the active ingredients in which are amphetamines. Adderall is also used to treat narcolepsy or daytime sleep disorders. Stimulants speed up some of the functions of the central nervous system, like blood pressure and heart rate, and raise a person’s alertness and attention levels while helping to control impulses. When used as directed, Adderall is considered to be a highly effective prescription medication.

As of the year 2012, more than 8 billion prescription stimulants had been sold, a number that was four times higher than it had been 10 years prior, The New York Times reports. Generally speaking, with increased availability and use comes misuse and abuse.

Adderall is a commonly abused stimulant drug that serves to increase focus and energy levels, and decrease the desire to eat or need to sleep. Adderall may be abused as a weight loss drug, as a “party drug” to get “high,” or in an attempt to get ahead at work or school as a “study drug” or “smart drug.”

It is classified as a Schedule II controlled substance by the Drug Enforcement Administration (DEA), which is the highest level of regulation for a drug with approved medicinal uses. This tight federal control signifies Adderall’s high potential for diversion and abuse. The National Survey on Drug Use and Health (NSDUH) reports that at the time of the 2014 survey, around 1 million Americans (aged 12 and older) were currently abusing stimulant drugs like Adderall.

Adderall to Get Ahead

College can be a trying time for many people, and there is such pressure for young adults to get good grades that they may seek out an edge to do so. The Substance Abuse and Mental Health Services Administration (SAMHSA) published a NSDUH study on Adderall abuse among fulltime college students in 2006 and 2007, and found that 6.4 percent abused Adderall in the past year. These fulltime college students were more than twice as likely to abuse the drug than their peers who did not attend college on a fulltime basis. The number of students using Adderall for nonmedical purposes as a “study aid” may even be higher on some college campuses, with as many as 30 percent of students abusing the stimulant drug, CNN reports. Adderall can make it possible to stay awake and study longer, and it can help users to maintain focus.

College students are not the only ones using Adderall for nonmedical purposes, however. Its abuse among professionals and young adults may be on the rise as well, CBS News postulates. According to the NSUDH of 2014, people between the ages of 18 and 25 abuse stimulant drugs more often than any other age group. CBS News further reports that between 2006 and 2011, nonmedical use of Adderall rose almost 70 percent for this age demographic.

Prescription drug abuse is considered to be any use of a prescribed medication outside of a necessary and legitimate prescription. This means that if a person takes more Adderall at a time than prescribed, takes it after a prescription runs out, invents symptoms in order to get the drug, “shops” different doctors for prescriptions, or uses Adderall without a prescription, it is considered drug abuse. Individuals most commonly get Adderall from a relative or friend who has a prescription for the drug, and this may make Adderall seem safer than other drugs since it initially comes from a doctor’s office. Students who do suffer from ADHD may give or sell their medication to students who don’t have the disorder.

Spotting Adderall Abuse

Adderall usually comes in small blue capsules in an extended-release or a more immediate-release form. The pills may be swallowed, crushed and then snorted or smoked, or crushed and then dissolved into liquid and injected.

Empty pill bottles, evidence of a powdery substance, mirrors, straws, rolled-up dollar bills, smoking apparatuses, or rubber tubing and syringes may be tangible signs of drug abuse. Physically, a person who abuses Adderall will eat and sleep less while taking the drug, which can result in drastic weight loss, changes in appetite levels, and irregular sleep patterns. A person may stay awake for hours or days, and then when the drug wears off, sleep for long periods of time. Mood swings, from energized, euphoric, hyper-focused and project-oriented to depressed, anxious, and fatigued, may be indicative of the ups and downs of Adderall intoxication and subsequent “crashes.”

Adderall can last between six and 12 hours, Stanford School of Medicine states, depending on the formulation of the drug, the manner of its abuse, and how much of it was taken at a time. Grades may actually suffer, as a result of Adderall abuse, as research shows that individuals who abuse prescription stimulant drugs like Adderall may actually have lower GPAs than those who don’t abuse the drugs, per NIDA.

The Harm in Abusing Adderall

Stimulant drugs not only increase blood pressure, body temperature, respiration levels, and heart rate, but they also disrupt the normal functioning, production, and absorption of some of the brain’s neurotransmitters. Dopamine is one of the brain’s natural chemical messengers that tells a person when to feel happy, and Adderall can cause a flood of this neurotransmitter in the brain. When this happens, a person may experience a “high.”

Adderall may be abused in large amounts as a “party drug” in order to feel this euphoric effect. It may also commonly be mixed with other drugs or alcohol, as SAMHSA reported that almost 90 percent of the college students who abused Adderall in the year before the national survey also admitted to binge drinking in the previous month, and 50 percent of these students were considered to be heavy drinkers. SAMHSA also reports regular rates of polydrug abuse in the past year among college students who abused Adderall:

9 percent also abused marijuana

9 percentabused prescription painkillers

9 percent abused cocaine

5 percent also used prescription tranquilizers for nonmedical purposes

Mixing Adderall with other drugs or alcohol makes it more dangerous and may lead to an unintended and negative reaction. All substances may amplify the effects of each other, worsening possible side effects and heightening the odds for a life-threatening overdose.

Altering the drug also increases the risks associated with use. Crushing the drug to snort, smoke, or inject it bypasses the way it is supposed to be absorbed into the body through the gastrointestinal system and sends the drug straight into the bloodstream instead. When the extended-release form (Adderall XR) is crushed and abused, the entire dosage of the drug is released at once instead of in a time-controlled manner, and overdose risks go up exponentially. An Adderall overdose occurs when the functions of the central nervous system are increased to dangerously high levels and may result in stroke or heart attack that can be fatal. The Drug Abuse Warning Network (DAWN) of 2011 publishes that more than 17,000 Americans obtained treatment for the nonmedical use of a drug like Adderall (amphetamine-dextroamphetamine prescription drug) in an emergency department (ED) that year.

Risks of Long-term Abuse

When used regularly, Adderall’s stimulant effects may damage the heart and cardiovascular system, potentially causing heart problems and other complications. Drastic and unhealthy weight loss and malnutrition may also be side effects of long-term Adderall use. When someone abuses a stimulant drug for a long time, instead of the desired effects, hostility, paranoia, and psychosis may result, NIDA publishes.

The method of abuse can lead to specific side effects as well. For instance, snorting Adderall can damage the nasal and sinus cavities, and cause respiratory issues, chronic nosebleeds, or damage to the nasal septum. Smoking it can also damage the lungs and respiratory system, while injecting Adderall may increase the risk for developing an infectious disease such as HIV/AIDS or hepatitis, cause scarring or “track marks,” and lead to skin infections or collapsed veins. Fillers and additives used to make Adderall capsules or tablets may clog blood vessels and create additional complications when injected as well.

As a stimulant drug that alters a person’s brain chemistry, chronic Adderall use or abuse can cause drug dependence that can lead to addiction. Dependence is when the brain has become so used to the changes that Adderall makes in the brain that it expects its continued disruption. Without Adderall, a person may begin to suffer from withdrawal symptoms as the drug wears off or leaves the system. Adderall withdrawal symptoms include:

Fatigue

Depression

Insomnia and disrupted sleep, including vivid dreams

Difficulties thinking clearly or concentrating

Anxiety

Tremors

Irregular heart rate and blood pressure

Irritability

Agitation

Increased appetite

Suicidal thoughts

Drug cravings

Drug dependence and withdrawal may also be signs of addiction, which is a disease affecting brain circuitry, motivation, reward processing, and impulse control. Addiction has many behavioral side effects as well, as an individual may be unable to control their drug use and therefore may continue to use Adderall for longer, in higher doses, and even in full awareness of the potential dangers of abusing it. Social withdrawal and relationship problems may be common as well as increased risk-taking behaviors, mood swings, and obsession with obtaining and using Adderall. Individuals battling addiction may not do well at work or school, and may shirk family and other responsibilities. Individuals who suffer from Adderall addiction may try to stop taking the drug many times and be unsuccessful in doing so.

Recognizing and Treating Adderall Addiction

Stimulant abuse may be on the rise as the pressures to get and stay ahead in school and professionally can feel overwhelming. Individuals may take a drug like Adderall, not thinking that it is a big deal or seeing the danger or harm in doing so. In fact, CNN reported on a study of college students in 2008 that found that over 80 percent did not view the nonmedical use of an ADHD medication like Adderall as dangerous. Stimulant drugs can be highly addictive, however, and even if they are not used to get “high,” they can still cause a wide range of potential side effects and lead to dependence and addiction with regular use. Between 2010 and 2012, the number of people entering into substance abuse treatment centers who cited stimulant drugs as their number one drug of abuse rose 15 percent, per The New York Times.

Treatment comes in many forms and, in the case of a stimulant drug like Adderall, it often begins with detox. Detox is the method of safely removing Adderall from the body. If a person has been abusing it in large doses for a long time, they may be heavily dependent on the drug. Medical detox can provide a secure environment staffed by medical and mental health professionals to ensure the person’s safety during this time. Medications may be used to manage Adderall withdrawal during medical detox, and 24/7 monitoring and supervision can help to make sure the individual does not present a danger to themselves or others while attaining a safe level of physical stabilization. Adderall may also be slowly tapered down in dosage over a period of time during detox to keep drug cravings and withdrawal symptoms to a minimum. By slowly weaning off Adderall, some of the more intense withdrawal symptoms may be avoided or reduced.

Beyond detox, substance abuse treatment programs may be either residential or outpatient. Clients will engage in group and individual therapy as well as life skills training workshops and educational opportunities to better themselves. Adderall abuse treatment programs often include behavioral therapies that work to improve self-confidence while teaching individuals how negative thoughts can lead to destructive behaviors. Stress management and coping mechanisms are taught as are relapse prevention techniques and improved communication skills. Trained professionals can aid individuals in determining why they may have turned to Adderall abuse initially.

Addiction treatment may not look the same for any two people as addiction is a highly personal disease, making individual treatment plans important. A detailed evaluation can help to uncover if there are any co-occurring disorders, like untreated ADHD, that also need to be managed and treated at the same time.

Long-term recovery may be sustained with the help of support groups or a 12-Step program that can continue beyond the initial treatment. Building a new social network of individuals with the same goals can be empowering and beneficial in recovery and beyond.